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3rd yr 2nd sem > HEMA2 - Secondary Hemostasis > Flashcards

HEMA2 - Secondary Hemostasis Flashcards

1
Q

Coagulation is a process whereby, on ___, ___, ___, ___ interact on the surface of platelets to form fibrin clot.

A

Vessel injury
Plasma proteins
Tissue factors
Calcium

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2
Q

___ formed in primary hemostasis and ___ formed in secondary hemostasis

A

Platelet plug
Fibrin

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3
Q

4 COAGULATION FACTORS

A

1 - Found in plasma
2 - Synthesized in the liver except for Factor III and IV
3 - They circulate in the blood in an inactive form except calcium and thromboplastin
4 - Activated only when needed

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4
Q

The year when the INTERNATIONAL COMMITTEE FOR STANDARDIZATION OF THE NOMENCLATURE OF THE BLOOD CLOTTING FACTORS name the coagulating factors:

A

1958

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5
Q

There are ___ coagulation factors, which are
interdependent.
List them all.

A

14
I, II, III, IV, V, VII, VIII, IX, X, XI, XII, XIII, PK, HMWK

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6
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor I

A

-Fibrinogen
-None
-Fibrin Clot

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7
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor II

A

-Prothrombin
-Prethrombin
-Serine protease

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8
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor III

A

-Tissue Factor
-Tissue Thromboplastin
-Cofactor

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9
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor IV

A

-Calcium
-None
-Already an active form

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10
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor V

A

-Proaccelerin
-Labile factor / Accelerator globulin
-Cofactor

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11
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor VII

A

-Proconvertin
-Stable factor / Serum Prothrombin Conversion Accelerator (SPCA) / Autoprothrombin I
-Serine protease

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12
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor VIII

A

-Anti hemophiliac Factor A
-Anti hemophiliac globulin / Platelet Cofactor I
-Cofactor

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13
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor IX

A

-Plasma Thromboplastin Component (PTC)
-Anti hemophiliac Factor B / Christmas Factor / Platelet Cofactor 2
-Serine protease

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14
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor X

A

-Stuart Prower Factor
-Autoprothrombin II
-Serine protease

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15
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor XI

A

-Plasma thromboplastin Antecedent (PTA)
-Anti hemophiliac C
-Serine protease

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16
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor XII

A

-Hageman Factor
-Glass factor / contact factor
-Serine protease

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17
Q

Give the

Preferred name:
Synonyms:
Active form / function:

of Factor XIII

A

-Fibrin Stabilizing Factor
-Laki lorand Factor / Fibrinase / Fibrinoligase / Phase transglutaminase
-Transglutaminase

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18
Q

Give the

Synonyms:
Active form / function:

of Prekallikrein

A

-Fletcher factor
-Serine protease

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19
Q

Give the

Synonyms:
Active form / function:

of High Molecular Weight Kininogen

A

-Fitzgerald factor
William factor
Flaujeac factor
Contact activation cofactor
-Cofactor

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20
Q

PK AND HMWK does not have assigned roman numerals because they belong to:

A

kallikrein and kinin system

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21
Q

Molecular weight of

FACTOR I (FIBRINOGEN)
FACTOR II (PROTHROMBIN)
FACTOR V (PROACCELERIN)
FACTOR VII (PROCONVERTIN)
FACTOR VIII (ANTI-HEMOPHILIC A FACTOR)
FACTOR IX (ANTI-HEMOPHILIC B FACTOR)
FACTOR X (STUART-PROWER FACTOR)
FACTOR XI (ANTI-HEMOPHILIC C FACTOR)
FACTOR XII (CONTACT FACTOR)
FACTOR XIII – FIBRIN STABILIZING FACTOR

HIGH MOLECULAR WEIGHT KININOGEN (HMWK)

PREKALLIKREIN (PK) (FLETCHER FACTOR)

A

I - 341,000
II - 63,000
V - 300,000
VII - 60,000
VIII - 1,000,000
IX - 62,000
X - 58,900
XI - 160,000
XII - 80,000
HMWK - 120,000
PK - 85,000

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22
Q

Factor I / Fibrinogen:
Normal value in plasma

A

200 - 400 mg/dl

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23
Q

Purpose of Factor I / Fibrinogen

A

Upon exposure to thrombin, it will form fibrin

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24
Q

Factors manufactured in the liver / Produced in the liver

A

FACTOR I (FIBRINOGEN)
FACTOR II (PROTHROMBIN)
FACTOR V (PROACCELERIN)
FACTOR VII (PROCONVERTIN)

FACTOR IX (ANTI-HEMOPHILIC B FACTOR)
FACTOR X (STUART-PROWER FACTOR)
FACTOR XI (ANTI-HEMOPHILIC C FACTOR)
FACTOR XII (CONTACT FACTOR)
FACTOR XIII – FIBRIN STABILIZING FACTOR
HIGH MOLECULAR WEIGHT KININOGEN (HMWK)
PREKALLIKREIN (PK) (FLETCHER FACTOR)

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25
Q

Half-life of

FACTOR I (FIBRINOGEN)
FACTOR II (PROTHROMBIN)
FACTOR V (PROACCELERIN)
FACTOR VII (PROCONVERTIN)
FACTOR VIII (ANTI-HEMOPHILIC A FACTOR)
FACTOR IX (ANTI-HEMOPHILIC B FACTOR)
FACTOR X (STUART-PROWER FACTOR)
FACTOR XI (ANTI-HEMOPHILIC C FACTOR)
FACTOR XIII – FIBRIN STABILIZING FACTOR
HIGH MOLECULAR WEIGHT KININOGEN (HMWK)

A

I –> 3-4 days
II –> 60 hours
V –> 12-14 hours
VII –> 4-6 hours
VIII –> 12 hours
IX –> 24 hours
X –> 40 hours
XI –> 45 hours
XIII –> 3-5 days
HMWK –> 6.5 days

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26
Q

Factors active in

A) intrinsic and extrinsic pathway:
B) intrinsic pathway
C) extrinsic pathway

A

A*
FACTOR I (FIBRINOGEN)
FACTOR X (STUART-PROWER FACTOR)
FACTOR XIII – FIBRIN STABILIZING FACTOR

B*
FACTOR VIII (ANTI-HEMOPHILIC A FACTOR)
FACTOR IX (ANTI-HEMOPHILIC B FACTOR)

C*
FACTOR III (THROMBOPLASTIN)

<acts>
</acts>

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27
Q

Purpose of FACTOR II (PROTHROMBIN)

A

When exposed to V, Xa, PF3, and Ca++, it is
converted to thrombin

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28
Q

Factors that are vitamin K dependent

A

FACTOR II (PROTHROMBIN)
FACTOR VII (PROCONVERTIN)
FACTOR IX (ANTI-HEMOPHILIC B FACTOR)
FACTOR X (STUART-PROWER FACTOR)

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29
Q

2 portions of FACTOR II (PROTHROMBIN)

A
  1. Pro-portion (Fragment 1.2) – responsible for the binding the prothrombin molecule
  2. Thrombin portion (Prethrombin 2)
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30
Q

lipoprotein found in tissue: what factor?

A

FACTOR III (THROMBOPLASTIN)

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31
Q

FACTOR III (THROMBOPLASTIN) are Exceptionally high concentrations are found in the ___ and ___

A

brain
lungs

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32
Q

Factor with no enzymatic activity

A

FACTOR III (THROMBOPLASTIN)

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33
Q

Required in the several steps in coagulation pathway: what factor?

A

FACTOR IV (IONIZED CALCIUM)

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34
Q

Precursor to a cofactor that speeds the
transformation of prothrombin to thrombin: what factor?

A

FACTOR V (PROACCELERIN)

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35
Q

It is the most unstable factor and deteriorates rapidly at room temperature: what factor?

A

FACTOR V (PROACCELERIN)

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36
Q

Activated by tissue thromboplastin: what factor?

A

FACTOR VII (PROCONVERTIN)

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37
Q

Two functional subunits of FACTOR VIII (ANTI-HEMOPHILIC A FACTOR):

A
  1. VIII:C – procoagulant
  2. VIII:vWF (VIII:Ag and VIII:R)
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38
Q
  • (Large portion) VIII:vWF is produced in ___ and ___;
  • (Small portion) VIII:C production site in ___ of the liver
A
  • endothelial cells & platelets
  • Kupffer cells
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39
Q

___ (Related antigen) is the antigenic portion of the molecule capable of stimulating antibody production and measured by immunoassays

Factor VIIIR:RCo (___) demonstrates ristocetin cofactor activity and is important in platelet aggregation

A

VIIIR:Ag

Related Ristocetin

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40
Q

Acts as a carrier for the coagulant portion of the Factor VIII complex; constitutes greater that 90% of this complex

A

VON WILLEBRAND FACTOR

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41
Q

VON WILLEBRAND FACTOR is synthesized in the ___ and ___ and present in the α granules of the platelets

A

endothelium & megakaryocytes

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42
Q

Deteriorates rapidly in stored plasma like factor V

A

Factor VIII

43
Q

Abnormalities of Factor VIII are the most common hereditary coagulation disorders (e.g., ___ and ___)

A

hemophilia A & von Willebrand disease

44
Q

FACTOR X (STUART-PROWER FACTOR)

Activated form acts with ___, ___, and ___ to form active thromboplastin

A

V
Ca++
PF3

45
Q
  • One of the contact factors of the intrinsic system
  • High Molecular Weight Kinninogen (HMWK) is needed as a cofactor with XII for its activation
A

FACTOR XI (ANTI-HEMOPHILIC C FACTOR)

46
Q

FACTOR XII (CONTACT FACTOR)

Contact factor in the intrinsic system – activated by negatively charged substances such as exposed ___.
In vitro, it is activated by ___.

A

collagen
glass

47
Q

Three functions of XIIa (which are aided by cofactor HMWK):

A
  1. Activate XI
  2. Converts prekallikrein (PK) to kallikrein
  3. Activates plasminogen in the fibrinolytic system
48
Q

A deficiency of Factor ___ is the ONLY factor deficiency that causes no coagulation problems

A

XII

49
Q

Necessary to form a stable clot – causes crosslinking of fibrin monomers: what factor?

A

FACTOR XIII – FIBRIN STABILIZING FACTOR

50
Q

2 functions of HMWK

A
  1. Acts as a cofactor with Factor XII to:
    a. Activate Factor XI
    b. Convert prekallikrein (PK) to kallikrein
    c. Activating plasminogen
  2. Converted to kinins by kallikrein which cause:
    a. Inflammatory reactions
    b. Pain
51
Q

5 functions of PK:

A

a) When converted to kallikrein by Factor XII it then loops back and accelerates the activation of larger amounts of Factor XII

b) Converts HMWK to kinins

c) Activates plasminogen

d) Activates the complement system

e) Acts as a chemotactic factor to attract
macrophages

52
Q

4 COAGULATION FACTORS

A

Substrate
Zymogen / enzyme precursor
Cofactor
Calcium

53
Q

When zymogens/enzyme precursors (inactive form) are converted into enzymes (active form) they become ___ or ___

A

SERINE PROTEASES
TRANSGLUTAMINASE

54
Q

3 PHYSIOLOGIC FUNCTIONS OF PROCOAGULANTS

A

COFACTORS
SERINE PROTEASE
TRANSGLUTAMINASE

55
Q

COFACTOR + SERINE PROTEASE = ___ AND ___

A

STABILITY
REACTIVITY

56
Q

Proteolytic enzymes of trypsin family that activates other specific factors in the coagulation sequence

A

SERINE PROTEASE

57
Q

___ is the only substrate in the cascade that does not become an activated enzyme because it is the only ultimate product of clot
form

A

Fibrinogen

58
Q

Catalyzes the transfer of amino acid in gamma chains of fibrin polymer

A

TRANSGLUTAMINASE

59
Q

3 PHYSICAL PROPERTIES OF PROCOAGULANTS (FUNCTIONAL GROUPS)

A

FIBRINOGEN GROUP
PROTHROMBIN GROUP
CONTACT GROUP

60
Q

Consumed in coagulation (they are present in plasma but not in aged serum)

A

Fibrinogen Group

61
Q

Have the highest MW of all of the factors

A

Fibrinogen Group

62
Q

Most labile group:

FIBRINOGEN GROUP
PROTHROMBIN GROUP
CONTACT GROUP

A

Fibrinogen Group

63
Q

Factors included in Fibrinogen Group:

A

1, 5 + 8 = 13

64
Q

Synthesized in the liver in the presence of Vitamin K

A

PROTHROMBIN GROUP

65
Q

Inhibitors of Vit K:

A

a) Dietary Vit K Deficiency
b) Antibiotics that sterilize intestinal tract
c) Oral anticoagulant therapy

66
Q

Prothrombin Group is not consumed during clotting except factor ___, therefore FVII, IX and X are present in plasma and serum

A

II

67
Q

PROTHROMBIN GROUP is precipitated with ___ (absent in the “adsorbed plasma”)

A

barium sulfate

68
Q

Factors included in Prothrombin Group:

A

2+ 7 = 9, 10

69
Q

Factors included in Contact Group:

A

XI, XII, HMWK, PK

70
Q

Contact Group requires negatively charged particle/substrate (in vivo: ___; in vitro: ___)

A

collagen
kaolin/glass tube

71
Q

CONTACT
PROTHROMBIN
FIBRINOGEN

Vit. K dependent:

A

No
Yes
No

72
Q

CONTACT
PROTHROMBIN
FIBRINOGEN

Adsorbed by BaSO4 or Alum. hydroxide

A

Partially
Yes
No

73
Q

CONTACT
PROTHROMBIN
FIBRINOGEN

Consumed in coagulation

A

Partially
No except II
Yes

74
Q

CONTACT
PROTHROMBIN
FIBRINOGEN

state other characteristics

A

Fairly stable

Heat labile VII, IX, X are reduced by oral contraceptives

Storage labile (V and VIII) Acute phase reactant

75
Q

Peptides of low MW composed of amino acids

A

Kinin

76
Q

PK (___ – activated form)
Kininogen (___,___)
Kinin (___)

A

kallikrien
LMWK, HMWK
bradykinin

77
Q

COAGULATION & THE KININ SYSTEM play roles in:

A
  1. Intrinsic coagulation activation
  2. Activation of fibrinolysis
  3. Kinin formation
  4. Complement system activation
78
Q

COAGULATION & THE COMPLEMENT SYSTEM

Function:

A

Lyse antibody coated cells

79
Q

COAGULATION & THE COMPLEMENT SYSTEM

___ activates C1 which will cleave C3 to C3a and C3b

A

Plasmin

80
Q

COAGULATION & THE COMPLEMENT SYSTEM

C1 inactivator inhibits ___, ___, ___, ___ and ___

A

complement activation
XIIa
XIa
plasmin
kallikrein

81
Q

3 THEORIES OF BLOOD COAGULATION :

A

MORAWITZ THEORY, 1905
HOWELL’S THEORY
CASCADE/WATERFALL THEORY, 1964

82
Q

PT + CA++ + Thromboplastin = Thrombin

Fibrinogen + Thrombin = Fibrin (blood clot)

What theory?

A

MORAWITZ THEORY, 1905

83
Q
  1. Prothrombin is inactivated by antiprothrombin (heparin)
  2. Thromboplastin neutralizes antiprothrombin and releases prothrombin
  3. PT + Ca++ = Thrombin
  4. Thrombin + Fibrinogen = Fibrin clot

What theory?

A

HOWELL’S THEORY

84
Q
  • Widely accepted until now
  • Extrinsic is an old name according to Henry’s
  • It involves 3 Pathways:

What theory?

A

CASCADE/WATERFALL THEORY, 1964

85
Q

3 Pathways According to Cascade / Waterfall Theory:

A

1 - Extrinsic / Tissue Factor Pathway

2 - Intrinsic / Contact Activation Pathway

3 - Common Pathway

86
Q

Pathway is activated by the release of tissue thromboplastin into the plasma from injured tissue cells

A

Extrinsic/Tissue Factor Pathway

87
Q

Pathway is activated by exposure of contact factors to the subendothelium (collagen). “Intrinsic” because all components are found in circulating blood

A

Intrinsic/Contact Activation Pathway

88
Q

Pathway begins with the activation
of Factor X by either intrinsic/extrinsic pathways

A

Common Pathway

89
Q

3 ENZYME COMPLEXES

  • Factor VIIa + Tissue Factor complex
    –> VIIa/TF/Ca = activates Factor __ and Factor __
  • Factor IXa + Factor VIIIa +Ca + PL complex
    –> “___ complex”
    –> IXa/VIIIa/Ca/PL = activates additional Factor X
  • Factor Xa + Factor Va + Ca + PL complex
    –> “___ complex”
    –> Xa/Va/Ca/PL = activates prothrombin to
    thrombin
A
  • X and IX
  • tenase
  • prothrombinase
90
Q

EVENTS THAT HAPPEN IN THE
EXTRINSIC PATHWAY:

A
  • When there is tissue trauma or injury, the extrinsic pathway is activated by releasing tissue thromboplastin (Tissue Factor).
  • Tissue factor activates factor VII and it converts to activated factor VII, (VIIa).
  • VIIa combines with Tissue factor in the presence of calcium ions and activates factor X, and it converts to (Xa)
91
Q

EVENTS THAT HAPPEN IN THE
INTRINSIC PATHWAY:

A
  • Injury or exposure of blood to collagen causes the activation of Factor XII to XIIa (partially) with the help of co-factor the HMWK (converts PK to K).
  • XIIa, acts on factor XI and causes its activation to XIa
  • XIa, acts on Factor IX and activates to IXa
  • IXa with factor VIIIa, combines with calcium ions and phospholipid (tenase complex) causes the activation of factor X to Xa
92
Q

EVENTS THAT HAPPEN IN THE
COMMON PATHWAY:

A
  • Xa, in the presence of calcium ions, Factor Va and Phospholipid forms the Prothrombin Activator (Prothrombinase complex) will activate Prothrombin (Factor II) to Thrombin
  • Thrombin acts on Fibrinogen to form a Fibrin monomer
  • Fibrin monomer cannot form a clot so, Fibrin Stabilizing Factor or Factor XIII, helps the Fibrin monomer to form a FIBRIN MESH
  • Fibrin mesh attracts the platelets, phospholipids and etc., and forms a stable fibrin clot
93
Q

OTHER COMPONENTS OF COAGULATION

A
  • Regulatory factors: Protein C and S
  • Physiologic inhibitors:
  • AT III, complement I-inhibitor
  • Alpha2-macroglobulin, alpha1-antitrypsin,
  • Plasminogen activators, plasminogen activator inhibitors,TFPI
94
Q

3 STAGES OF COAGULATION

A

Stage I – Generation of Thromboplastin Activity
Stage II – Formation of Thrombin
Stage III – Formation of Fibrin clot

95
Q

COMPONENTS OF EXTRINSIC
PATHWAY

A
  • Factor VII – short half-life
  • Factor III/Tissue factor – found in lung, brain, placenta, etc
96
Q

COMPONENTS OF INTRINSIC
PATHWAY

A
  • Factor XII
  • Factor XI
  • Factor IX
  • Factor VIII
  • HMWK
  • Prekallikrein
97
Q

COMPONENTS OF THE
COMMON PATHWAY

A
  • Factor X
  • Factor V
  • Factor II
  • Factor I
  • Factor XIII
98
Q

___ Pathway

  • In vivo activation – damaged vascular
    endothelium
  • In vitro activation – exposure of coagulation
    factors to negatively charged surface such as
    glass
A

Intrinsic

99
Q

___ Pathway

  • In vivo – release of TF from damaged tissue
  • In vitro – addition of tissue extract (PL) to
    samples
A

Extrinsic

100
Q

___ bind to phospholipid (PF3)
surface until enzyme, substrate and cofactor is formed

A

Clotting factors

101
Q

Final product is a ___ or clot which
completely stops bleeding

A

fibrin mesh

102
Q

Extrinsic:
a) activated upon release of ___
b) Factor ___ and ___

Intrinsic:
a) activated upon exposure to ___
b) Factors:

Common:
a) activated by ___
b) Factors:

A

thromboplastin
III and VII

collagen
VIII, IX, XI, XII, PH HMWK

both pathways
I, II, V, X

103
Q

___ is the physical manifestation of fibrin formation which represents the end result of a series of reactions of coagulation factors (plasma proteins) a.k.a. clotting factors, plasma factors, pro-coagulants, coagulation proteins

A

Visible coagulum

3rd yr 2nd sem (4 decks)

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